探讨不同程度颅脑损伤（TBI）患者在不同时间点血清脑源性神经营养因子（BDNF）浓度变化规律以及血清BDNF浓度与预后的关系。

选择自2016年10月至2018年10月青海省人民医院神经外科收治的149例TBI患者为研究对象，根据患者入院时的GCS评分将其分为轻型组（13~15分）52例、中型组（9~12分）49例、重型组（3~8分）48例。对照组为35例健康体检者。分析不同伤情组在不同时间点BDNF动态变化关系及其与对照组BDNF之间的关系。TBI患者伤后3个月采用GOS评分对患者预后进行评定，分为预后良好组（4~5分）98例、预后不良组（1~3分）51例，对比2组不同时间点血清BDNF浓度的差异，并对不同时间点血清BDNF值与患者入院时GCS评分及伤后3个月GOS评分进行相关性分析。

（1）轻、中、重型组患者1、7、14 d血清BDNF浓度与对照组比较，第1天轻型组与对照组比较，差异无统计学意义（P>0.05），其余各组及不同时间点均明显低于对照组，差异具有统计学意义（P=0.001）；（2）中、重型组患者血清BDNF浓度于1、7、14 d均低于轻型组（P=0.001），重型组患者血清BDNF浓度于1、7、14 d低于中型组，差异具有统计学意义（P=0.001）；（3）随访3个月，预后不良组与预后良好组各时间点BDNF浓度比较，差异具有统计学意义（P=0.001）；（4）TBI患者伤后1、7、14 d血清BDNF浓度水平与GCS评分呈正相关，与伤后3个月GOS评分亦呈正相关。

TBI患者血清BDNF浓度变化与不同伤情及预后有相关性，可作为临床早期判断TBI伤情和预后的指标之一。

To investigate the change rule of serum brain-derived neurotrophic factor (BDNF) concentration at different time points in patients with traumatic brain injury (TBI) of different degrees and the relationship between serum BDNF concentration and prognosis.

One hundred and forty-nine TBI patients admitted to Department of Neurosurgery, Qinghai Provincial People’s Hospital from October 2016 to October 2018 were analyzed. According to GCS scores at admission, the patients were divided into mild group (13-15 scores) 52 cases, moderate group (9-12 scores) 49 cases, and severe group(3-8 scores) 48 cases. The control group consisted of 35 healthy subjects. The dynamic change relationship of BDNF in different injury groups at different time points and the relationship between BDNF and control group were analyzed. The prognosis of TBI patients was evaluated by GOS scores 3 months after injury. They were divided into good prognosis group (4-5 scores) 98 cases and poor prognosis group (1-3 scores) 51 cases. The difference of serum BDNF concentration between the two groups at different time points was compared, and the correlation between serum BDNF value at different time points and the GCS scores at admission and the GOS scores 3 months after injury were analyzed.

(1) The concentrations of serum BDNF in the mild, moderate and severe groups on day 1, 7 and 14 were compared with those in the control group, and had no significant statistical difference on day 1 (P>0.05). The concentrations of serum BDNF in the other groups and at different time points were significantly lower than those in the control group (P=0.001); (2) The concentration of serum BDNF in the moderate and severe groups were lower than those in the mild group on day 1, 7 and 14 (P=0.001). The serum BDNF concentrations in severe group were lower than those in medium group on day 1, 7 and 14 (P=0.001); (3) After 3 months’ follow-up, there was a significant difference between poor prognosis group and good prognosis group at each time point (P=0.001); (4) There was a positive correlation between the serum BDNF levels and the GCS scores in TBI patients on day 1, 7 and 14 after injury. The score was also positively correlated with GOS 3 months after injury.

The changes of serum BDNF concentrations in patients with TBI are related to different injuries and prognosis. It can be used as one of the indicators for early diagnosis of TBI severity and prognosis.